A new bipartisan committee’s working group will gather on Capitol Hill throughout the coming months to find ways to improve electronic health records, according to Senate health committee chairman Lamar Alexander (R-Tenn.) and ranking member Patty Murray (D-Wash.).

The group will work to find five or six ways to “make the failed promise of electronic health records something that physicians and providers look forward to instead of something they endure,” Murray said in an announcement.

All members of the Senate health committee are invited to be a part of the working group. Staff meetings begin this week, with participation from health IT professionals, industry experts and government agencies.

The working group’s goals include the following:

Help providers improve quality of care and patient safety.

Facilitate interoperability between EHR vendors.

Empower patients to engage in their own care through access to their health data.

Protect privacy and security of health information.

The working group isn’t the only way Alexander and Murray are pushing for change when it comes to EHRs.

The Government Accountability Office placed the Veterans Affairs Department’s healthcare system on a list of high-risk programs for 2015, saying at an April 29 Senate Veterans’ Affairs Committee hearing that the agency needs to address inadequate oversight and ambiguous policies.

“Risks to the timeliness, costeffectiveness, quality and safety of veterans’ healthcare, along with other persistent weaknesses GAO and others have identified in recent years, raised serious concerns about VA’s management and oversight of its healthcare system,” said GAO Healthcare Director Debra Draper at the hearing.

GAO prepared testimony (pdf) says VA operates one of the largest healthcare delivery systems in the nation, including 150 medical centers and more than 800 community-based outpatient clinics.

Enrollment in the VA healthcare system has grown significantly, increasing from 6.8 to 8.9 million veterans between fiscal years 2002 and 2013, GAO says.

Over this same period, Congress has provided steady increases in VA’s healthcare budget, increasing from $23.0 billion to $55.5 billion.

At the hearing Draper outlined five major areas that put the VA at risk of failing to provide adequate healthcare to veterans including ambiguous policies and inconsistent processes, inadequate oversight and accountability, information technology challenges, inadequate training for VA staff and unclear resource needs and allocation priorities.

John Daigh, the VA’s assistant inspector general, agreed with Draper’s assessment of the Veterans Health Administration.

“VHA is at risk of not performing its mission as the result of several intersecting factors,” Deigh said. “VHA has several missions, and too often management decisions compromise the most important mission of providing veterans with quality healthcare.”

Daigh focused on the Veterans Integrated Service Networks – regional offices that are set up to oversees VA medical centers in certain areas – saying the current VISN structure has not worked effectively to support and solve problems facing hospitals.

One role of the VISNs is to make sure medical providers at each facility are doing their job properly with periodic reviews.

Daigh said in prepared testimony (pdf) that a forthcoming VA OIG report found that in hospitals where there are specialty units with small numbers of providers, it is difficult to obtain unbiased peer reviews of clinical cases and assessments of clinical performance by peers.

That lack of data makes it difficult for VISN’ to accurately assess medical care providers. But medical centers shouldn’t be shouldering all of the blame, Daigh said.

“The VISN structure has been inconsistently effective in addressing this issue,” he said.

Each VISN has a different internal organization and each medical facility has a different internal structure.

“This lack of standardization makes the dissemination of information and policy to facilities challenging and the acquisition of critical data from facilities more difficult,” Daigh said.

For more:
– go to the hearing page (webcast and prepared testimony available)

U.S. Surgeon General Vice Admiral Vivek H. Murthy meets with Dr. Jonathan Woodson, assistant secretary of Defense for Health Affairs, at the Pentagon on March 11, 2015, to discuss the Military Health System’s critical role in support of the National Health Strategy.

eaders of the Military Health System met with the newly confirmed U.S. Surgeon General at the Pentagon on March 11. Dr. Jonathan Woodson, assistant secretary of Defense for Health Affairs, and Air Force Lt. Gen. Douglas Robb, director of the Defense Health Agency, discussed military health and the MHS’ critical role in support of the National Health Strategy in their first meeting with Vice Admiral Vivek H. Murthy since his confirmation by the U.S. Senate in December 2014.

“Our partnership with the Public Health Service has been instrumental in helping the Department and the Military Health System achieve its mission,” said Woodson. “Public Health Service officers have worked side-by-side with us in our military hospitals and clinics, in our laboratories, in support of our global health mission, and as part of the medical team serving all of our beneficiaries. One of the most prominent areas where we have collaborated is on implementation of health prevention and wellness initiatives. I look forward to continuing to work in close partnership with Admiral Murthy to promote health and healthy behaviors for our force and all of our beneficiaries.”

The meeting gave the leaders the important opportunity to discuss the Military Health System as a strategic asset in support of national security objectives, and the important role DoD plays in supporting the National Health Strategy, especially in areas such as reducing obesity and tobacco use.

“Our military medical personnel are all members of the larger federal team focused on improving the health and wellness of the entire country,” said Robb. “I am privileged to have Public Health Service officers working with me in the Defense Health Agency on a number of critical health matters. We’re one team engaged in one fight. It was a great opportunity to show Admiral Murthy everything we have to offer, and to express our appreciation for the talented people the Public Health Service shares with us.”

A veterans advocacy group says a complete overhaul of the Veterans Affairs health system — to include partially privatizing services — is needed to improve care for current veterans and ensure the system’s future viability.

A report issued by a task force formed by Concerned Veterans For America calls for revamping VA medical facilities under a non-profit government organization and proposes changes that would shift more veterans into private health insurance programs.

The recommendations in “Fixing Veterans Health Care” would “advance long-term reforms of the current system, while addressing the immediate needs of veterans,” said the authors, including Tennessee Republican and former Senate Majority Leader Dr. Bill Frist and former Rep. Jim Marshall, a Vietnam veteran and Georgia Democrat.

According to the task force, the current VA system is broken and unsustainable.

“If proactive and fundamental reforms are not made soon, demographic realities will force further drastic and reactionary changes,” the authors wrote.

Details of the 100-page report were addressed during a five-hour conference on VA health care hosted by CVA in Washington, D.C., on Thursday.

The recommendations included:

*Splitting the Veterans Health Administration into two entities, a hospital system responsible for medical centers and clinics and a health insurance oversight office.

*Closing underutilized health facilities and streamlining services.

*Providing health care at VA medical facilities for veterans with service-connected medical conditions who want to stay in the system; and offering private health coverage to veterans who can’t get to a VA health facility or want to see a private physician.

Under the plan, veterans who have severe disabilities or fall in higher priority groups would get more money to pay for premium health care coverage; lower priority groups would have access to private care but would be required to pay more in cost-shares.

Although Congress passed the Veterans Access Choice and Accountability Act last year that gave VA $15 billion to hire new physicians and let veterans seek private care, CVA officials say the law doesn’t’ go far enough to fix VA’s chronic problems.

“The veterans’ health system is still broken. The VA Choice program does not allow for true choice because VA still determines who can access the program … and in the future, VA is going to see massive underutilization. We need to solve these problems,” said Daniel Caldwell, CVA’s legislative and political director.

“Veterans can go out and get health care when they want it … that’s what we were trying to do with the Choice card. But VA has erected obstacles which … are clearly in violation with the intent of the law,” Sen. John McCain, R-Ariz., said at the summit.

The VA medical system became embroiled in a scandal last year over patient appointment wait times and VA administrators gaming the system to appear to be meeting access standards.

In some cases, veterans waited months for care and some died while on waiting lists.

The troubles brought about passage of the Veterans Access Choice and Accountability Act, which Frist, Marshall and others called a good “first step” but a “temporary one whose funding is expected to run out in a few years.”

“In the end, VACAA has kept the VA bureaucracy in control, and offers few real choices to veterans. This task force seeks to flip that equation. Our proposal puts veterans in control of their health care,” they wrote.

The report’s release quickly drew comments and criticism from those skeptical of its findings and recommendations.

VA Secretary Bob McDonald said taking care of veterans at VA is a “sacred mission,” and added that while outside care should supplement care provided by VA doctors, it should not replace it.

“Reforming VA health care cannot be achieved by dismantling it and preventing veterans from receiving the specialized care and services that can only be provided by VA,” McDonald said.

Paralyzed Veterans of America said it welcomes discussion on veterans health care reform but cautioned against privatized care because it would remove protections veterans have being treated within the VA system.

“Privatizing health care for veterans will create a cottage industry for ambulance chasers who will be the only available option for veterans with medical malpractices cases,” PVA officials said in a release.

Stewart Hickey, national executive director of AMVETS, addressed the summit, saying “most of what is in the report is good.” But he added that persuading other veterans groups to support the plan would be difficult because they are interested in preserving the status quo.

None said they would sponsor a draft version of a bill proposed in the report, the Veterans Independence Act, but agreed that the proposals would start a dialogue about long-term reform of VA health.

Frist and Marshall acknowledged as much in the report. “No plan is perfect. While we believe that our proposal would significantly improve veterans health care, we know the plan would benefit from continued refinement and input from interested parties,” they wrote.

Nearly 9 million veterans are enrolled in VA health care.

According to VA, the department made more than 2 million authorizations for veterans to get care from non-VA providers from May 1, 2014 through Feb. 1, equaling $6.7 billion in care.

The figures represent a 45-percent increase when compared with the same period in previous years.

CVA officials said one of the goals of its recommendations is to steer VA back toward caring primarily for veterans with service-connected conditions.

“Eligibility would be limited to service-connected disabilities and those who are indigent. VA health was never intended to be an entitlement program,” Caldwell said.

Since its creation in 2012, CVA has drawn attention for its outspoken criticism of President Obama and held a summer-long “defend freedom” tour that decried current government policies, with members saying those policies undermine both military and economic security.

In turn, the group has been criticized for receiving most of its financial backing from conservative political groups.

Officials noted that the report has bipartisan authorship and support and urged lawmakers to read it and consider its recommendations.

“[Fixing VA] has to be a bipartisan project … similar to when we passed welfare reform. This is an important report that creates a large structural proposal for how you really put veterans first,” former Speaker of the House Newt Gingrich said.

What’s in an EHR? As the Department of Defense prepares to select a new electronic health record system, some are advocating that it go with an open-source solution—not just to benefit of the DOD but to use the $11-billion program to benefit the healthcare industry at large.

Why it matters to the DOD

Most commercial EHR systems are developed around FFS, which is not particularly relevant to the DOD.

In a new report released by the Center for New American Security titled “Reforming the Military Health System,” the authors argue that the selection of a closed, proprietary system would trap the DOD into vendor lock, health data isolation and a long-term contract with technology that will age rather than evolve.

Co-author Stephen L. Ondra, a former senior advisor for health information in the White House Office of Science and Technology Policy, tells Healthcare Dive that an open-source solution could more easily adapt to meet future modernization and interoperability needs, and could more creatively be tailored to the DOD’s requirements.

Ondra says most commercial EHR systems are developed around the fee-for-service revenue cycle, a model that is not particularly relevant to the DOD and its healthcare system. He says an EHR for the DOD should be focused on the clinical care management aspect of these programs, which would require lengthy and expensive modification.

He argues that a proprietary system would be inadequate as it would leave the DOD with a single vendor’s solutions. “You don’t have some of the creativity and innovation that an open source system would have because you’re limited to a single vendor’s view and skills,” Ondra says.

In addition, he notes, proprietary systems have less incentive to provide interoperability solutions because their business model aims to lock people into using that particular system.

“I think the commercial systems are very good at what they do,” Ondra said. However, “they are not ideally designed for efficiency and enhancement of care delivery, and I think the DOD can do better with an open source system both in the near-term, and more importantly in the long-term, because of the type of innovation and creativity that can more quickly come into these systems.”

Why it matters to everyone

“If the DOD goes with a closed, proprietary system, it could stifle innovation in the industry.”

Whoever gets that $11-billion award is going to have a lot of money to develop EHR technology—and whether they are serving an open or closed solution will determine whether the innovations remain stovepiped from the rest of the industry, notes report author Peter L. Levin, a former chief technology officer at the Department of Veterans Affairs.

“If the DOD were to choose to go with a closed, proprietary system, it has the potential of stifling innovation in the rest of the industry,” Levin says. “If they go with an openly-architected, standard space and modular system, then really in a very simple way, they are spreading the innovation resources around.”

“Instead of concentrating it all in one place and letting that vendor own all of the innovation, they’ll be able to nourish and support the various components that comprise these complicated enterprise resource platforms in a way that will not only be beneficial to the DOD and the country in the long run, but will tremendously benefit the country and other kinds of innovations now,” Levin said.

Imagine if consumers could only talk to people with same phone carrier.

Levin adds that the same arguments for the DOD to select an open-source EHR system apply to private healthcare systems as well. He asks consumers to imagine if they could only talk to people with same phone carrier, or only go to gas stations for their particular make of car.

He argues that private hospitals and private payers have been unwittingly supporting the continued isolation and segmentation of the commercial solutions.

“Healthcare suffers tremendously in terms of cost and outcome because of these isolated systems,” he says, “and that’s just as true for the private sector as it is for the public sector.”

Ondra adds that the DOD’s choice will set an example from which both open and closed source providers could learn.

“I think that a major government contract would send the message that the current systems, as good as they are, are not fully meeting the needs of clinical care in a way that is efficient for the provider,” he says.

“Going to an open source for the DOD gives the opportunity to have rapid development of things that are more helpful to care delivery, more efficient for the provider, because the customer then is the deliverer of care, and not the finance department of a care delivery system,” Ondra said.